咽鼓管球囊扩张术治疗难治性分泌性中耳炎的疗效分析

Effect of balloon eustachian tuboplasty on refractory otitis media with effusion

目的评价咽鼓管球囊扩张术治疗难治性分泌性中耳炎的效果。方法对15例24耳诊断为难治性分泌性中耳炎患者进行咽鼓管球囊扩张术。患者纳入标准：鼓膜切开置管≥3次，病程超过2年迁延不愈的中耳炎。主要评价指标包括主观症状改善、耳内镜检查、纯音听力测试、声阻抗和CT扫描。结果所有患者成功接受手术。术后8～24个月复查，手术前后患者主观症状、耳内镜检查、CT扫描有效率95.8%。手术后10～24个月纯音听阈测试患耳术后言语频率气导听力较术前提高（P 〈0.05），术前患耳平均气骨导差为36.15 dB，患耳术后平均气骨导差为14.35 dB（P 〈0.05）。术后鼓室导抗图达到A型为83.3%。1例（1耳）术后自觉患侧听力无提高，耳内闷胀感，B型鼓室导抗图，行乳突轮廓化联合鼓膜置管术见中耳及乳突有肉芽样胆固醇结晶。结论咽鼓管球囊扩张术治疗难治性分泌性中耳炎的疗效显著，难治性分泌性中耳炎可能是咽鼓管球囊扩张术的最佳适应证之一。

ObjectiveTo evaluate the effect of balloon eustachian tuboplasty on refractory otitis media with effusion. Methods24 ears （15 patients） of refractory otitis media with effusion received balloon eustachian tuboplasty were included. Inclusion criteria： All the patients had tried for tympanostomy tube insertion at least 3 times but failed and duration of more than two years. The main measures included subjective symptoms, ear endoscopy, pure tone audiometry, acoustic impedance, CT scan. ResultsAll patients successfully accepted surgery. After 8 to 24 months later, by comparison the subjective symptoms, ear endoscopy, CT scan before and after surgery in patients found efficiency up to 95.8 %. After 10 to 24 months, pure tone audiometry showed the average air conduction hearing of impaired ear increased than the preoperative （P 〈0.05）. The average air-bone gap of preoperative impaired ear was 36.15 dB, and the average air-bone gap of postoperative impaired ear was 14.35 dB （P 〈0.05）. Of 83.3% impaired ear achieve type A tympanogram after surgery. But one case （1 ear） had no conscious increased hearing, ear fullness, type B tympanogram, and found the middle ear and mastoid cholesterol granuloma-like crystals by mastoid contour combining tympanostomy. ConclusionThe effect of balloon eustachian tuboplasty on refractory otitis media with effusion is significant, and intractable otitis media with effusion maybe one of the best indications for balloon eustachian tuboplasty.